Effects of Different Exercise Interventions on Body Composition in Women with Overweight and Obesity: A Systematic Review and Network Meta-analysis

ObjectiveThis study aimed to investigate the effects of different types of exercise on body composition in women with overweight or obesity and to compare the relative effectiveness of these interventions using a systematic review and network meta-analysis. MethodsA systematic search of 7 electronic databases was performed from database inception to September 2025. Randomized controlled trials (RCTs) involving women with overweight and obesity were included according to predefined eligibility criteria. Interventions consisted of 7 different types of exercise, while comparators were no exercise or normal-lifestyle condition. The primary outcome measure was body fat percentage (BFP). Secondary outcome measures included, body mass index (BMI), waist circumference (WC), fat mass (FM), and lean body mass (LBM). Risk of bias assessment was undertaken. Network meta-analysis was performed using a random-effects model, and consistency was assessed with surface under the cumulative ranking curve (SUCRA) used for ranking the relative effects of exercise types. Certainty assessment was performed using the Confidence in Network Meta-Analysis (CINeMA) framework. ResultsA total of 44 randomized controlled trials comprising 2384 female participants were included. The network meta-analysis revealed that, compared to the control, multiple exercise modalities significantly reduced body fat percentage (BFP) in women with overweight or obesity. Aerobic exercise of vigorous intensity (AE(V)) was ranked as the most effective intervention for reducing BFP (SUCRA = 79.7), whereas resistance training (RT) demonstrated the weakest effect (SUCRA = 18.3). The effectiveness of exercise modalities exhibited distinct outcome-specific patterns: AE(V) was optimal for reducing body mass index (SUCRA = 93.9), AE(MV) was most beneficial for decreasing fat mass (SUCRA = 80.9), and waist circumference (SUCRA = 67.6). Furthermore, subgroup analysis by publication date indicated that the optimal exercise modality for reducing BFP has changed over time, with AE(V) being superior in recent studies and AE(M) in earlier studies. ConclusionThe effects of exercise on body composition in women with overweight and obesity are outcome-specific. AE(V) may be most effective for reducing BMI and BFP, AE(MV) for improving WC and FM, while RT shows potential for enhancing LBM. The finding that the optimal modality for reducing BFP has changed over time highlights the need for contemporary, evidence-based prescriptions. These results provide a critical evidence base for tailoring exercise programs to individual patient goals in clinical practice.